“Isolated Carotid Bifurcation” and Vertebral-Carotid Artery Bypass for Common Carotid Artery Occlusion

Abstract

Symptomatic common carotid artery (CCA) occlusion is relatively rare, and requires an elaborate vascular reconstruction procedure with which many neurosurgeons are unfamiliar. We describe a case of CCA occlusion managed by vertebral artery (VA)-internal carotid artery (ICA) saphenous vein interposition graft. An 80-year-old man presented with deterioration of consciousness, transient aphasia, and severe right hemiparesis. Angiography revealed proximal occlusion of the left CCA with concomitant patent ICA. Cerebral blood flow measurement using iodine-123 N-isopropyl-p-iodoamphetamine and single photon emission computed tomography showed corresponding hemodynamic insufficiency of the left hemisphere. The patient underwent a novel revascularization procedure, in which the saphenous vein was used as an interposition graft between the V 3 segment of the VA and the left proximal ICA. Postoperative course was uneventful, and patency of the bypass graft was confirmed. VA-ICA bypass with interposition graft is an alternative treatment option for symptomatic proximal CCA occlusion.

Alternative Bypass Technique Using Radial Artery Graft between V3 Segment of Vertebral Artery and Middle Cerebral Artery: Technical Note

“…19,20 Although the indication of a high-flow bypass for ischemia is controversial, its effectiveness has already been previously reported in the cases with symptomatic CCA occlusion. 19,21,22 Our case 2 showed progressive cognitive impairment and a nearly occluded STA that had been used for previous bypass surgery. The V3-RA-M2 bypass was one of the few resolutions.…”

Superficial temporal artery to middle cerebral artery anastomosis for neovascular glaucoma due to common carotid artery occlusion

“…[ 6 ] The most common technique performed for CCA occlusion is subclavian artery to carotid artery bypass, using an interposed graft from the saphenous vein. [ 9 ]…”

“…[ 18 24 ] Previously, surgical options for them include aortic arch to ICA bypass, subclavian artery to MCA bypass, axillary artery to ICA bypass, half-collar bypass, transverse cervical artery to ECA bypass, and vertebral artery to ICA. [ 1 9 16 21 ] In patients with Type 1B CCA occlusion, persistent reduction of perfusion pressure may induce ischemic attacks due to inappropriately developed collateral circulation. [ 24 ] Previously, STA-MCA anastomosis combined with subclavian, transverse cervical, or thyrocervical artery to ECA bypass has been indicated for them.…”